Evidence For Combining Hormone Therapy And Radiation Treatment
Bolla M, Collette L, Blank L, et al. Long-Term Results with Immediate Androgen Suppression and External Irradiation in Patients with Locally Advanced Prostate Cancer : A Phase III Randomised Trial. Lancet 2002 360:1036. PMID: 12126818.
Bolla M, Gonzalez D, Warde P, et al. Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and Goserelin. New England Journal of Medicine 1997 337:295300. PMID: 9233866.
DAmico AV, Schultz D, Loffredo M, et al. Biochemical Outcome Following External Beam Radiation Therapy With or Without Androgen Suppression Therapy for Clinically Localized Prostate Cancer. Journal of the American Medical Association 2000 284:12803. PMID: 10979115.
DAmico AV, Manola J, Loffredo M, et al. Six-Month Androgen Suppression Plus Radiation Therapy Versus Radiation Therapy Alone for Patients with Clinically Localized Prostate Cancer: A Randomized Controlled Trial. Journal of the American Medical Association 2004 292:8217. PMID: 15315996.
Denham JW, Steigler A, Lamb DS, et al. Short-Term Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer: Results from the Trans-Tasman Radiation Oncology Group 96.01 Randomised Controlled Trial. Lancet Oncology 2005 6:84150. PMID: 16257791.
Nesslinger NJ, Sahota RA, Stone B, et al. Standard Treatments Induce Antigen-Specific Immune Responses in Prostate Cancer. Clinical Cancer Research 2007 13:1493502. PMID: 17332294.
Secondary Treatment Following Relapse
Hormone therapy may also be used as a secondary or salvage treatment when PSA levels rise following initial prostate cancer treatment, indicating the cancer has returned. This situation is known as biochemical recurrence. The salient points to keep in mind are that hormone therapy is most often used as a salvage treatment when PSA doubling time is less than six months, indicating that the cancer is aggressive or may have already metastasized.
Whats The Typical Dosage
Hormone therapy can be used alone or in combination with other therapies. It may also be used before or after other therapies.
Lupron is administered by injection. The dosage will vary according to your particular situation. Here are some typical dosage options your doctor may prescribe:
- 1 mg once per day, varying the injection site
- 7.5 mg every 4 weeks
- 22.5 mg every 12 weeks
- 30 mg every 16 weeks
- 45 mg every 24 weeks
If you stop taking Lupron, youll start producing testosterone again.
You will experience some changes when your hormone levels fluctuate or have a substantial drop. Its a good idea to talk about this in advance so youre not caught off guard.
Consider asking some of these questions when you consult with your doctor:
- Why do you recommend treatment with Lupron?
- How often will I have to take the drug?
- Will I administer it myself or will I need to come in to the clinic?
- How often will we test to see if its working?
- How long will I have to take it?
- What should I do if I miss a dose or if I stop taking it?
- What are the potential side effects, and can we do anything about them?
- Are there any other medications, supplements, or foods I should avoid while taking Lupron?
- If it doesnt work, what are the next steps?
According to the American Cancer Society, the relative five-year survival rates for men with prostate cancer, compared to men without the disease, are:
Your doctor can give you an idea what to expect from your treatment with Lupron.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
Does Lupron Shrink The Prostate
For Prostate Cancer From the urologist, Lupron is a hormone to shrink the prostate prior to the x-ray treatments for cancer. I have lived with BPH for several years, and it did not shrink the prostate in my opinion. Subsequently, I learned from the Oncologist it was for lowering the PSA. and it did lower the PSA.
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Trew Have You Asked Your
Trew, have you asked your oncologist about monthly injections? That is what my husband does. I don’t know, but I think it is a lower dose than the injections you get less frequently. Wonder if that would ease some of the side effects? I have no idea, just a question.My hubby hates the shots too. Heck, I hate them too!
Androgens And The Prostate
Testicular hormone secretion has long been known to influence prostate growth. In the 18th century, surgical castration was noted to cause prostate atrophy in adult animals and halt prostate growth in younger animals. In the late 19th century, castration was utilized to treat urinary retention caused by prostatic hyperplasia. In one early case series published in 1895, over half of the patients experienced improvement of urinary symptoms after surgical castration.
Androgen deprivation therapy was first proposed as a treatment for prostate cancer in 1940 when castration was utilized to provide pain relief, stabilize tumor burden, and reduce serum acid phosphatase in prostate cancer patients with osseous metastatic tumors.,
Given the morbidity of surgical orchiectomy and associated clinical side effects, alternative anti-androgenic measures have been sought. One early approach attempted chemical castration through injection of the female hormones stilbestrol and hexestrol to neutralize the effect of testicular androgens. The mechanism of this effect was discovered many years later: estrogen inhibits hypothalamic GnRH release through a negative feedback mechanism.
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How Long To Continue Hormone Therapy
|May 24, 2012 – 10:46 pm|
In late 2011 I was diagnosed with prostate cancer, high PSA number and Gleason score. I decided on radiation treatment, started with hormone therapy, followed by 5 weeks of external beam radiation and just had seed implants. At first my Oncologist said the hormone trerapy could last 2 to 3 years, then perhaps 2 years and at my last meeting with him he suggested that 6 months to 2 years could be sufficient. I’m sure like everyone else, I would like to end the hormone therapy as soon as possible. Does anyone have a suggestion on where I could find some information on how long I need to stick with this part of the treatment? I would also appreciate comments or opinions from anyone that has gone thru this treatment.
What To Expect During Treatment
Doctors often use hormone therapies, such as Lupron, in combination with radiation therapy or other treatments. They may also use it following surgery.
Healthcare professionals administer Lupron as a depot, which is a small implant that they inject under the persons skin. The individual can often choose an injection site that is suitable for them. Common injection sites include:
- upper arms
- outer thighs
The treatment regimen for Lupron will depend on the individuals circumstances, and a person can work with their doctor to determine the best dosage. Some typical dosages include:
- 7.5 mg one injection every 4 weeks
- 22.5 mg one injection every 12 weeks
- 30 mg one injection every 16 weeks
- 45 mg one injection every 24 weeks
When a person first starts treatment with Lupron, they may have a testosterone flare. Later on, they may experience side effects due to having very low testosterone levels in their body. After treatment stops, testosterone levels begin to return to normal.
When a person first takes Lupron, their testosterone levels may rise, or flare, before dropping to very low levels. For some people, particularly those with advanced prostate cancer, a testosterone flare can temporarily cause their symptoms to worsen.
The symptoms of a testosterone flare can include:
- blockage of the ureters, the tubes that carry urine from the kidneys to the bladder
- bone pain
- spinal cord compression
- issues with urination
- loss of muscle mass
- radiation therapy
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Hormone Treatment Fights Prostate Cancer
Hormone therapy for prostate cancer has come a long way in the past few decades. Not so long ago, the only hormonal treatment for this disease was drastic: an orchiectomy, the surgical removal of the testicles.
Now we have a number of medications — available as pills, injections, and implants — that can give men the benefits of decreasing male hormone levels without irreversible surgery.
“I think hormonal therapy has done wonders for men with prostate cancer,” Stuart Holden, MD, Medical Director of the Prostate Cancer Foundation.
Hormone therapy for prostate cancer does have limitations. Right now, it’s usually used only in men whose cancer has recurred or spread elsewhere in the body.
But even in cases where removing or killing the cancer isn’t possible, hormone therapy can help slow down cancer growth. Though it isn’t a cure, hormone therapy for prostate cancer can help men with prostate cancer feel better and add years to their lives.
On average, hormone therapy can stop the advance of cancer for two to three years. However, it varies from case to case. Some men do well on hormone therapy for much longer.
Systemic Therapy For Metastatic Disease
The most common use of hormone therapy today is to treat men whose prostate cancer has metastasized to other parts of the body. If prostate cancer cells escape the prostate, they migrate first to surrounding structures, such as the seminal vesicles and lymph nodes, and later to the bones or, rarely, to other soft tissues.
Hormone therapy is recommended as a palliative treatment, to relieve symptoms such as bone pain. And while hormone therapy is not a cure, in that it cant eliminate prostate cancer completely, it often extends life for many years. By reducing testosterone levels, hormone therapy can shrink a prostate tumor and its metastases and slow further progression of the cancer for so long that sometimes a man with this disease dies of something other than prostate cancer.
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What Types Of Hormone Therapy Are Used For Prostate Cancer
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
Impact On Everyday Care
Fatima Karzai, M.D., of the Genitourinary Malignancies Branch in NCIs Center for Cancer Research, called relugolix an exciting option for men with advanced prostate cancer. Its most obvious role will be in men with advanced prostate cancer who also have cardiovascular disease, Dr. Karzai said.
Although trial participants who received relugolix had a more than 50% lower risk of serious cardiac events, she said its unclear exactly why it poses less of a threat to the heart. Some studies have suggested, she noted, that the difference in how the two drugs work may also influence how they affect plaque deposits in the cardiovascular system.
Relugolix is not the first GnRH antagonist to be approved by FDA to treat men with advanced prostate cancer. Degarelix was approved more than a decade ago. However, degarelix is given as a monthly injection, and the injections can cause intense pain at the injection site, greatly limiting its use.
Dr. Karzai noted that there are still questions about using relugolix in patient care. For example, there might be problems with mens ability to take a pill every day, as opposed to only having to get an injection of leuprolide or related drugs every few months.
Dr. Morgans agreed that this could be a concern but noted that men with more advanced forms of prostate cancer also receive other drugs that are taken as pills and have been generally good about using them as prescribed.
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Options In Hormone Therapy
Testosterone levels in the body can be reduced either surgically or with drugs. The surgical option is castration, achieved by removing the testicles during a bilateral orchiectomy. Once the only option, it has since been supplanted by drugs that lower testosterone levels to amounts achieved by surgery.
For men, normal testosterone levels range from 300 to 1,000 ng/dl. The FDA requires that any new drug used in hormone therapy for prostate cancer lower testosterone levels to 50 ng/dl or less. In my practice, I usually try to lower levels even further, to 20 ng/dl.
Dr Roach: Hot Flashes Remain Post
Dear Dr. Roach: Im a 76-year-old man who was treated for prostate cancer starting in summer 2017. Following radiation therapy, I was given Lupron injections every six months for two years. Its been two years since my last injection, but I still experience hot flashes as a result. Will these hot flashes stay with me for the rest of my life? My urologist assured me that the hot flashes would subside approximately a year after the final shot.
Dear D.T.: Leuprolide is a medicine that prevents the body from making testosterone. Back in 1941, depleting testosterone was proven to slow prostate cancer growth, but even in the first group of subjects, there were men with severe hot flashes. The sudden drop in testosterone causes vasomotor instability, meaning that the blood vessels in the skin suddenly dilate, causing an intense heat sensation. The whole body can cool down with this, leading sufferers to feel cold afterward.
I cant predict how long these symptoms will last, but it does not shock me that they have continued for two years. Given that they seem to be quite bothersome, you should ask your urologist or oncologist about treatment. Just as with menopausal women who have hot flashes, there are treatments that can reduce, though perhaps not eliminate, the number of hot flashes you get per day.
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How Will I Know If My Treatment Is Working
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.
How Effective Is It
Hormone therapies, such as Lupron, are often effective in combination with other treatments for people with late-stage prostate cancer. Many doctors do not recommend hormone therapy during the early stages of this disease.
One potential issue is that prostate cancer can become resistant to LHRH agonists over time in some people.
According to the ACS, doctors may recommend hormone therapies, such as Lupron, for:
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What Happens If I Stop Lupron Depot
If Lupron treatment is stopped, testosterone levels can rise and your cancer may worsen. Do not discontinue Lupron Depot unless your doctor tells you to stop treatment.
In men, testosterone is reduced to castrate concentrations with Lupron Depot treatment. This is called medical castration, as opposed to surgical castration when the testicles are removed surgically. The testicles make most of the testosterone in a man, about 95%. The adrenal glands above the kidney also produce a small amount of testosterone.
In patients with advanced prostate cancer, you may also receive other medicines along with Lupron Depot. These may include chemotherapy drugs, immunotherapy or targeted drug treatments, or corticosteroids depending upon your stage of cancer.
You may experience side effects with Lupron Depot treatment such as:
- hot flashes or sweats
What Are The Side Effects Of Hormone Therapy
Like all treatments, hormone therapy can cause side effects. These are usually caused by low testosterone levels.
Hormone therapy affects men in different ways and you may not get all of the possible side effects. Some men only get a few side effects or dont get any at all. This doesnt mean that the treatment isnt working.
Some men find their side effects improve or get easier to manage the longer theyre on hormone therapy. But if side effects dont improve, there are usually ways to manage them.
Side effects will usually last for as long as youre on hormone therapy. If you stop using it, the side effects should improve as your testosterone levels start to rise again.
Your side effects wont stop straight away it may take several months or years. For some men, the side effects may never go away completely.
The risk of getting each side effect depends on your type of hormone therapy and how long you take it for. If you have hormone therapy alongside another treatment, you may get side effects from that treatment as well.
Surgery to remove the testicles cant be reversed, so the side effects will be permanent. But there are treatments to help manage them.
Discuss the possible side effects with your doctor or nurse before you start or change your hormone therapy, or call our Specialist Nurses. If you know what side effects you might get, it can be easier to manage them.
Read more about prostate cancer and your sex life.
Strength and muscle loss
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